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Minor hemorrhage: ▪ Usually venous, stops spontaneously unless the patient has a bleeding disorder, taking anticoagulants. Severe hemorrhage ▪ A primary cause of shock. ▪ Internal hemorrhage resulting in shock without external evidence of hemorrhage. ▪ The internal spaces that ar...

Minor hemorrhage: ▪ Usually venous, stops spontaneously unless the patient has a bleeding disorder, taking anticoagulants. Severe hemorrhage ▪ A primary cause of shock. ▪ Internal hemorrhage resulting in shock without external evidence of hemorrhage. ▪ The internal spaces that are capable of housing large amount of blood include the retro-peritoneum, pelvis, chest, and thighs. Dr. Ahmad Aqel 2021 2 Control of External Hemorrhage 1. Apply direct, firm pressure (firm pressure dressing) 2. Pressure point: apply pressure on the involved artery at a site that is proximal to the wound 3. Elevate the injured part if possible.(immobilize extremity) 4. Apply tourniquet to an extremity when the external hemorrhage cannot be controlled Apply tourniquet just proximal to the wound Tag the patient with adhesive tape on the forehead with a “T,” stating the location of the tourniquet and the time applied. In case of amputation with uncontrollable hemorrhage, keep the tourniquet in place. Dr. Ahmad Aqel 2021 3  Internal bleeding S&S of internal bleeding: tachycardia, ↓ BP, thirst, apprehension, cool moist skin, or delayed capillary refill. Management: 1. Blood transfusion 2. Prepare the patient for possible surgery 3. Obtain ABG sample ▪ to evaluate pulmonary function and tissue perfusion. ▪ to establish baseline hemodynamic parameter ▪ used as an index for determining the amount of fluid the patient can tolerate and the response to therapy. 4. Put the patient in supine position and monitor closely. Dr. Ahmad Aqel 2021 5  TYPES OF SHOCK Shock: inadequate blood flow to tissues and cells of the body Anaphylactic shock: resulting from a severe allergic reaction producing an acute systemic vasodilation and relative hypovolemia Cardiogenic shock: resulting from impairment or failure of the myocardium Distributive shock: resulting from displacement of intravascular volume creating a relative hypovolemia and inadequate delivery of oxygen to the cells Hypovolemic shock: resulting from decreased intravascular volume due to fluid loss Neurogenic shock: shock state resulting from loss of sympathetic tone causing relative hypovolemia Septic shock: caused by widespread infection or sepsis Dr. Ahmad Aqel 2021 6 Stage 1: compensatory Stage 2: progressive Stage 3: irreversible Dr. Ahmad Aqel 2021 7  Stages of Shock Stage 1: compensatory The BP remains within normal limits. To maintain cardiac out put: Vasoconstriction,↑ heart rate,↑ contractility of the heart (This results from stimulation of the sympathetic nervous system and subsequent release of catecholamines (e.g., epinephrine, norepinephrine)). – Patients display “fight-or-flight” response. The body shunts blood from organs such as the skin, kidneys, and (GI) tract to the brain, heart, and lungs to ensure adequate blood supply to these vital organs. (As a result, the skin may be cool and pale, bowel sounds are hypoactive, and urine output decreases in response to the release of aldosterone and ADH). Dr. Ahmad Aqel 2021 8  Stages of Shock Stage 2: Progressive Stage In the second stage of shock, the mechanisms that regulate BP can no longer compensate, and the MAP falls below normal limits. Patients are clinically hypotensive; this is defined as a systolic BP of less than 90 mm Hg or a decrease in systolic BP of 40 mm Hg from baseline. The patient shows signs of declining mental status Dr. Ahmad Aqel 2021 9  Stages of Shock Stage 3: Irreversible Stage ▪ Patient does not respond to treatment. Organ damage occur ▪ BP remains low despite treatment ▪ Renal and liver dysfunction, compounded by the release of biochemical mediators, creates an acute metabolic acidosis. ▪ Anaerobic metabolism contributes to a worsening lactic acidosis. ▪ Respiratory system dysfunction prevents adequate oxygenation and ventilation despite mechanical ventilatory support ▪ The cardiovascular system is ineffective in maintaining an adequate MAP for tissue perfusion. Dr. Ahmad Aqel 2021 10  Stages of Shock Finding Compensatory Progressive Irreversible stage stage stage BP Normal 100 >150 Erratic RR >20 Rapid shallow Require MV SKIN Cold clammy Mottled, patechiae Jaundice URINE OUTPUT Decreased